Provider Demographics
NPI:1174262943
Name:MATOVCIK, KAYLOY (RN)
Entity Type:Individual
Prefix:MRS
First Name:KAYLOY
Middle Name:
Last Name:MATOVCIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MA
Mailing Address - Zip Code:01083-1276
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:261 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MA
Practice Address - Zip Code:01083-7929
Practice Address - Country:US
Practice Address - Phone:561-331-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308049163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse